Sweet’s Rules: Four simple rules I use each day to guide me as I diagnose and treat my infertile patients

During National Infertility Awareness Week, I’d like to share my four patient care rules. I made them up rather spontaneously rules of the road Sweet’s Rules: Four simple rules I use each day to guide me as I diagnose and treat my infertile patientsnearly 22 years ago and I still use them each and every day when I am uncertain of what to tell a patient or how we should proceed.

Before the rules are invoked, it is most important to first understand what brings patients to my clinic. By understanding the causes of their infertility, I will better be able to tailor a treatment plan specific to their needs. Some patients feel this is a waste of time and want to proceed immediately to treatment, but I strongly recommend understanding the issues first before proceeding forward.

So, once the evaluation is complete, my Sweet’s Rules are used to guide us forward-

1. Get my patients pregnant as fast as I can

Time can be an enemy and patients are not necessarily patient. We need to complete the evaluation quickly and move forward as most of my patients wanted to be pregnant many yesterdays ago. Some will call this a “duh!” rule, but it is still a good one to keep me moving forward as the patient desires.

2. Achieve success in the most cost-effective manner possible

We always want to choose the least costly conception method. This might even mean sending the patients on a date to try natural means for a tad bit longer. Hopefully, the successful patient potentially saves a bundle by my guiding them away from costly alternatives. Sometimes, adoption is also the best option and I’ll send them down this new road, if it is needed, even if the practice loses a patient. My cardinal rule is to treat the patients like family and tell them what I would tell someone close to me, regardless of the gain or loss to the practice. Practicing this way has always served may patients well.

3. Minimize complications (i.e., no litters)

I took an oath to do no harm and I take that oath very, very seriously. A multiple pregnancy can be a million dollar pregnancy with complications too long to list here. Always pull back, no matter how much pressure from the patient, if I fear a complication is likely.

4. Minimize the use of procedures with minimal chances of success

This may be the most important rule. I do not like being a “Gynechiatrist” (borrowed from the movie “Knocked Up”) by performing procedures that are unlikely to work. While some patients need to try a procedure destined for probable failure, to have closure and the inner knowledge that they gave it a shot, I prefer to move quickly through these treatments and get the patient to understand what will truly bring them to their goal.

I tell patients these rules when I am trying to guide them through their treatment plan. I believe it helps them to understand why I am telling them something, especially when they don’t necessarily want to hear it. Understanding my motivations, I believe, helps them to appreciate that I truly have their best interests at heart. By following these simple four rules, I will always keep my patients’ needs first and foremost.

While I may not be successful with all my patients, I will always try my best, give them the best information I can and provide options that simply make sense. Interestingly, these rules help me keep on the path, as much as they simultaneously guide my patients, as we make decisions and travel the infertility to fertility journey together.

DrSweet Headshot 17 03 28 150x150 Sweet’s Rules: Four simple rules I use each day to guide me as I diagnose and treat my infertile patients

By: Dr. Craig R. Sweet

Medical Director & Founder

What to Say & What Not to Say to the Infertile Patient

DrSweet Headshot 17 03 28 150x150 What to Say & What Not to Say to the Infertile PatientBy: Dr. Craig R. Sweet, Medical Director & Founder

(Reprinted from Florida Parenting News, February, 1994, revised September, 1999 and again April, 2011.)


Introduction:

Infertility affects nearly one in six couples. Approximately 40% of the time, the problem is related to the female partner, another 40% is related to male difficulties and 20% of the time both partners will have medical problems. Most of the time, infertility is a symptom of an underlying disease process, a disease process that the infertile patient has no control over. To these patients, infertility can be a crisis of the deepest kind. Every menstrual cycle represents a failure and is a time of grief for the potential child that never came to be.

The infertile patient or couple will often express their feelings through anger, frustration, feelings of inadequacy, depression and guilt. Relationships with family members who have children can suffer, marriages and relationships are strained and well-meaning friends and family can overload the patient with advice and pressure. Family and social gatherings become a reminder of infertility. Baby showers can be a traumatic experience. Mother's and Father's Day are often very, very difficult.

We want to offer some tips that provide support to patients who have not yet had the blessing of a beautiful child to love. With your assistance, most patients going though the process of trying to conceive can maintain a positive attitude.


What Not To Say…

Don't ask a childless person when they are going to have a child. They may be going through the process of trying to conceive, but have not yet achieved success. Asking them only reminds them of their problem and they need no extra reminders.

Don't relate stories of your fertility to them. Hearing “my husband just has to look at me and I get pregnant” is very annoying. While well meaning, the statement is insensitive and unhelpful.

Don't give advice such as “just relax,” “you are trying too hard” or “take a vacation.” All of these very common comments imply that patient has control of their fertility. Most of the time, these patients have absolutely no control over their fertility. Implying control leads to feelings of failure and guilt when this advice doesn't work. It simply is not their fault and they are doubtfully doing anything wrong in what they have done thus far.

Don't offer advice such as sexual timing, position, herbal medications or other totally unproven therapies. There are literally hundreds of old wives’ tales that, when followed, can drive an infertile patient nearly crazy. Their physician will have covered those natural aspects of their care that may maximize their chances for conception. Once again, please to not imply that they have a sense of control as they lost it long ago.

Don't express your derogatory personal opinions regarding insemination procedures, test-tube babies or adoption. Sometimes, these are their only hope for having a child. These are your opinions and uninvited advice is rarely neither desired nor constructive. You are absolutely entitled to your opinion; simply keep it your own. If they ask for your advice, then feel free to state your opinions, but do so in a kind and considerate manner.  Please, do not be judgmental.

Don't place blame by accusing the couple of exercising too much, eating the wrong foods or drinking alcohol. These patients may already be blaming themselves. Their physician will have already covered the medical and reproductive consequences of obesity, smoking, alcohol and recreation drugs. Support them in the cessation of these activities and minimize the guilt associated with their consumption. The guilt rarely leads to cessation but often moves the individual to increased consumption.

What You Can Say and Do…

Do provide couples with plenty of emotional support by saying “It must be difficult to go through this” and “I'm here to listen if you need to talk.”

Do remember that men can be just as emotional about the problem, sometimes even more so. They may feel their masculinity is at risk. Be sensitive to their egos and personality traits.

Do understand the couple's need for privacy.

Do try to understand that if they are your employees, frequent doctor's appointments may be necessary during business hours. Please try to accommodate them as much as possible. Not doing so may also be construed as a form of discrimination and place you at legal risk.

Do understand why they may not make it to a baby shower or a holiday event. These frequent events can become overwhelming for an infertile patient.

Do tell the infertile couple that there is hope.

Conclusions:
Please remember that the vast majority of infertile patients have minimal control of the diseases that causes their infertility. Giving them emotional support during this trying time is a wonderful way to assist them. Giving them subtle hints that they have control plants the seeds of personal failure in the minds of the infertile patient.

Please be kind, be thoughtful and always be supportive.

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Embryo Donation – Option for Infertile Couples & Waiting Lives

I recently had the opportunity to be on Theresa Erickson's Internet radio show, Voice America. Known as the Surrogacy Lawyer, Theresa is renowned for her work on behalf of many patients faced with infertility looking for third party options. During my interview, we discussed the option of embryo donation  from the physician, recipient and donor perspectives.

One of our donors, Tori, discussed her infertility experience as well as her and her husband's  decision to donate their remaining embryos following a  successful IVF procedure culminating in the delivery of her twins. You can see a picture of her twins and information regarding her amazing embryos by visiting our website.

emb application 4becb569b8fc3 Embryo Donation   Option for Infertile Couples & Waiting Lives

Tori's Twins!

Tori and her husband decided that they wanted to “pay it forward” to other infertile couples. Here is a combination of her own words during the interview and some other comments she told me separately:

“Donating the embryos brought on a wide range of emotions; some expected such as the happiness to help another infertile couple, peace in setting the embryos ‘free’ by finally making a decision on their fate and others were a bit of a surprise  such as a brief feeling of sheer panic that I ‘forgot’ something after leaving the clinic. The donation experience to me is like paying it forward to other infertile couples. I did not see any reason to leave the embryos suspended in time, did not want to see them destroyed and there was no reason to donate them to stem cell research when there are so many infertile couples in the world going through the same anguish I went through.

That feeling of anguish kept coming back, that longing and yearning for something that was so easy for others to have, yet so very difficult for me to obtain. I wanted to help someone relieve that awful feeling and by donating my embryos, I had a very good chance of doing just that.”

To listen to the show, please visit our Audio Gallery and click the play button to the right.

I am so thankful for people like Tori and other donors who consider giving their frozen embryos life while helping other people building their families at the same time. If you'd like more information on the process, please visit our embryo donation page on our Website, contact us at (239) 275-8118 or e-mail us at Fertility@DreamABaby.com.

Also, for additional details on surrogacy or fertility via third party assistance, I encourage you to read Theresa's book: Surrogacy and Embryo, Sperm and Egg Donation: What were you thinking?

Please stay tuned for the launching of our expanded embryo donation program called Embryo Donation International! I hope that many couples will consider to “pay it forward” just as Tori and her husband did.

Your thoughts and comments are always welcome.

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‘The Fertility Chase’ featuring Fort Myers physician and patients set to air May 15

Southwest Florida physician, Dr. Craig R. Sweet, a reproductive endocrinologist and medical director of Specialists in Reproductive Medicine and Surgery, and several of his patients will be featured in the new independently produced television series “The Fertility Chase” began airing on Saturday, May 15 from 8:30-9 a.m. on WE tv, the Women’s Entertainment cable television network. The half-hour program produced by Exodus Productions will highlight the issue of embryo donation and the story of 44-year-old Kerry Lewis, a patient of Sweet’s and mother-to-be.

“As I approached the age of 44, I said to myself, ‘even though I’m still not married, I have a lot of love to give’ so I pursued having a child on my own,” says Lewis. “With a history of reproductive problems, I was devastated to learn from my previous physician that I would need a hysterectomy. I would never have a child of my own.”

After researching her options including adoption, Lewis, a nurse, was referred to Sweet where she learned more about embryo donation and surrogacy. Through a process called cryopreservation or embryo freezing, excess embryos resulting from in vitro fertilization are stored for future use. When genetic parents elect not to use remaining embryos, rather than destroy the embryos or donate them to science, they may chose to donate their embryos to infertile patients. An estimated 500,000 embryos are currently in cryopreservation in the United States.

Lewis chose to accept donated embryos and a surrogate. Christina Lynn, a friend and fellow nursing colleague of Lewis, offered to be her surrogate.

Less than two weeks after Sweet transferred the donated embryos into Lynn, Lewis received the news that she had been hoping for.

“It was amazing to learn that Christina was pregnant and I would soon be a mother,” says Lewis. “I’m grateful to Christina for carrying my child and to Dr. Sweet and the miracle of modern medicine. Embryo donation is truly a gift of life.”

Lewis recently moved from Port Charlotte to Stuart but will return “home” to participate in the upcoming birth of her daughter.

Specialists in Reproductive Medicine and Surgery, P.A. is a reproductive endocrinology practice providing comprehensive and compassionate reproductive endocrine care including IVF, preimplantation genetic diagnosis (PGD), egg donation, embryo donation, gestational surrogacy, conventional surrogacy, oocyte cryopreservation, cryopreservation of ovarian/testicular tissues, sex selection, gynecology, genetics, endocrinology as well as menopausal diagnostic and treatment services.

For more information, visit http://www.dreamababy.com/the-fertility-chase.php or http://www.sweetfertility.com/. Become a fan of Dr. Sweet on Facebook and follow him on Twitter. Become a fan of The Fertility Chase on Facebook.

Southwest Florida fertility specialist, patients featured in new nationally televised series, ‘The Fertility Chase’

Local fertility patients and physician, Dr. Craig R. Sweet, a reproductive endocrinologist and medical director of Specialists in Reproductive Medicine and Surgery, will be featured in a new independently produced television series “The Fertility Chase” scheduled to begin airing on May 1, 8:30 – 9 a.m. EST on WE tv, the Women’s Entertainment cable television network. The launch of the series, produced by Exodus Productions, coincides with National Infertility Awareness Week, April 24 – May 1, a week dedicated to raising awareness about infertility, a condition affecting 7.3 million Americans. The segment featuring Sweet and his patients is scheduled to air on Saturday, May 15 and will highlight the issue of embryo donation.

One local couple featured in the show, Walter and Amy Costello from Sanibel, underwent in vitro fertilization following diagnosis and treatment for endometriosis, a leading cause of infertility. Under the care of Sweet and his staff, the couple implanted two embryos and chose to save their remaining four embryos to try for more children in the future or to donate to another infertile patient.

Through a process called cryopreservation or embryo freezing, excess embryos resulting from in vitro fertilization are stored for future use. An estimated 500,000 embryos are currently in cryopreservation in the United States.

“In addition to minimizing the opportunity for multiple births, cryopreservation gives families the opportunity to have more children in the future,” says Sweet. “In the event that patients choose not to transfer and use all of their remaining embryos, our patients are given the option to donate them to research or to other infertility patients who have chosen embryo donation to build their family.”

“In our case, we hope to use our embryos to grow our family someday,” says Amy. “However, should we decide not to do so, we have indicated our wishes to give the gift of life to another family through embryo donation.”

Less than two weeks after the Costello’s own embryos were implanted, the couple received long-awaited news: “We are expecting a baby boy, due on June 20, Father’s day,” says Amy. “It was a long, emotionally and financially difficult journey, but we couldn’t be happier. We are truly blessed.”

Specialists in Reproductive Medicine and Surgery, P.A. is a reproductive endocrinology practice providing comprehensive and compassionate reproductive endocrine care including IVF, preimplantation genetic diagnosis (PGD), egg donation, embryo donation, gestational surrogacy, conventional surrogacy, oocyte cryopreservation, cryopreservation of ovarian/testicular tissue, sex selection, gynecology, genetics, endocrinology as well as menopausal diagnostic and treatment services.

For more information, visit www.dreamababy.com. Become a fan of Dr. Sweet on Facebook and follow him on Twitter. Become a fan of The Fertility Chase on Facebook.

Tune Into The Fertility Chase

Tune into WE Network! Several of my patients and I will be featured in a new televised series, “The Fertility Chase” to begin airing on May 1, 8:30 – 9 a.m. EST. The half hour program produced by Exodus Productions will run over the course of eight weeks.

Producers from Exodus Productions invited several of the top fertility specialists from around the country to participate in the series. My patients and I agreed to take part to help raise awareness about treatment options, including embryo donation, available for the more than nine million couples suffering from infertility in the United States each year.

Through a process called cryopreservation or embryo freezing, fertility patients can save their excess embryos for a chance to have more children. In some cases, couples may choose to donate their remaining embryos to a needy individual or couple to pursue a chance at parenthood. It is a wonderful and amazing gift! Learn more at http://dreamababy.com

You can also visit the Fertility Chase Facebook fan page.

Sweet Success Story

The best part of my job is sharing two sweet words, “you’re pregnant!”

After a year and a half of trying to conceive, a young couple came to visit me on the advice of a friend and former patient. After a semen analysis revealed a low count and very poor morphology, we discussed the couple’s chances of becoming pregnant on their ownebsite Automation Center'>Website Automation Center

and their treatment options. Two rounds of insemination and in-vitro fertilization followed. Read more about this couple’s experience and their double success story on www.dreamababy.com

For more information or to schedule an appointment, call 239-275-8118.

Guest Opinion in The News-Press

Read my guest opinion in today’s The News-Press about the serious threat that Medicare reductions pose on patient care and physician practices. The quality of health care is at risk. Please read and take action today!

Dr. Sweet scores a new high of 98 percent on his recertification test!

As part of Dr. Sweet’s ongoing medical education, the American Board of Obstetrics & Gynecology requires annual recertification for members in the areas of Obstetrics & Gynecology as well as Reproductive Endocrinology & Infertility. This segment of the recertification involves the reviewing of articles and then testing. While Dr. Sweet has always been able to score 90 percent and above, the recent score of 98 percent was a surprise to him. “Either the tests are getting easier or I am finally getting a bit smarter. My guess is that it was the test,” quipped Dr. Sweet. “Now the pressure is really on. What am I going to do for the next year? If I score below 98 percent, will my patients think I am losing my touch?”

We're all very proud of Dr. Sweet his years of consistent high test scores. What a “sweet” achievement.

Congratulations!